Red alert on Dengue

The dengue epidemic has now reached full blown status. Over 44,000 confirmed cases of dengue during the first four and a half months of this year is evidence of this fact.

As health officials battle to save lives amid the heavy odds such as, shortage of hospital staff , lack of beds with 2-3 patients sharing a single bed, new issues and problems they are forced to face along with the dengue epidemic, has simply added to their woes.

With a red alert on dengue countrywide, the situation was serious enough for none other than the head of state, President Maithrapala Sirisena to summon a meeting with the Special Task Force on Dengue Prevention at the Presidential Secretariat, Tuesday . At the meeting, he reportedly instructed officials to submit a written report on the issues they faced when implementing their respective dengue control programs. He also reportedly said, a gazette notification would be issued declaring what steps had been taken by the public sector to combat dengue. The President also instructed health officials to conduct a three month long Dengue control program where the public and private sector would be called upon to allocate time to clean the inside and outside of their respective premises so as to reduce the risk of dengue spread.

The Sunday Observer spoke to several health officials for their comments and concerns with regard to implementing the respective dengue control programs. We also asked what interventions they had put in place and their future plans to combat the disease.

Our first contact was the Head of the Dengue Control Unit, Dr A.M.R. Thowfeek.

“ The most important tool to fight dengue is raising public awareness on how this preventable disease can affect the whole family, even if only one person becomes a victim. Prevention is the key. The public must realize their responsibility in keeping out the dengue carrying vector by maintaining their premises free of discarded tyres, small plastic containers, coconut shells, and by cleaning gutters and repairing blocked drains. They must also ensure that their neighbour’s garden is clean and the whole neighbourhood is free of mosquito attracting garbage”, he said. “We have already instructed schools, government institutes, construction sites, and religious places to clean their premises once a week at least for 1-2 hours. If they wish to have technical advice they may contact our unit tel 2434660. We have also allocated enough funds and directed the Army to build a temporary dengue ward.

We next contacted the Chief Medical Officer of the Colombo Municipality (CMC) Dr Ruwan Wijeyamuni.

He agreed that dengue was now in epidemic form with a huge increase in the number of confirmed cases countrywide. “If you look at the figures, in 2016, for the entire year we had 3,814 cases . This year, in the short period of just 41/2 months , the number of reported cases is already 1,886.i.e nearly 45% of last year’s figures,” he said.

Reason for spread

Q: What has caused this sudden surge?

“Three main factors have contributed to this. Firstly, dengue is a resident, basically an urban disease. It is very much linked to the population. Colombo has 37 sq . k.m of land. Within this very limited space is a resident population of 650,000 people and another 600,000 floating population. It means about 1.2 million population. This is the highest in the island.

Secondly, the human behaviour factor. Dengue is a man made disease caused by irresponsible behaviour. If everyone kept their gardens clean, there will not be breeding sites for mosquitoes to leave their larvae. Thirdly, the changing weather patterns. . Due to sporadic showers followed by sunshine, the scattered rains and very high temperature has made the larvae to hatch very fast”.

Q: So, what kind of interventions has the CMC done to reduce the dengue spread?

“We are the only city in the island which has started fogging infected adult mosquitoes. We use technical malathion ( in liquid form) and also Pasguard”.

Q: So, has it worked?

“Unfortunately, we are not seeing a resistance to Pasguard and have stopped using it. This has resulted in our stocks of Technical Malathion running dry. We are now desperately searching for alternatives and have sought the help of the Registrar of Pesticides and the WHO and have had discussions with the latter on this. As the mosquito bites at dawn, we need to kill the infected adult mosquitoes quickly. In addition, our officers go out very early in the morning to do fogging in high risk areas since most mosquitoes take their first blood feed between 5.30 and 7.30 a.m. Our officers also pay house visits to check on both, within and outside of homes. All those found guilty of allowing breeding sites for mosquitoes are warned and then punished. We have taken 483 people to court this year alone.”

Asked about the biggest offenders – namely schools, religious places and construction sites, he said, the CMC had launched a program called Zero Waste in schools, hotels and other construction sites where schoolchildren and workers were encouraged to compost their garbage; hotels asked to feed excess food waste to piggeries, and schoolchildren told to take home any non degradable items such as used lunch sheets, styrofoam boxes, used yoghurt cups, etc. “We have had a good feedback and most of them, including parents of children have been very cooperative”, he said.

Asked about the hundreds of small wayside cafes and boutiques which also did not keep hygienic environments, he said this was a big problem but assured they were being strictly monitored.

In a previous interview with the Sunday Observer early this year, he told us how his hospital was overrun by patients, following the dengue epidemic and how difficult it was for his limited staff to cater to the extra intake of patients amid a severe shortage of beds, bed pans, linen and other much needed facilities.

Had the situation changed by now, four months later we asked.

“No”, he said, in a voice of weary resignation. “ It has in fact got worse. We now admit between 150 to 250 dengue patients to our wards, daily. This is in addition to our other patients. Our wards are overcrowded , we are short of beds, linen, mats, 2-3 patients share one bed. We also don’t have enough staff, especially nurses. Sixty six of our nurses are on transfer. Although our nursing cadre is 1,300, we only have 640 for the whole hospital. Many of them work long hours beyond their call of duty, for which I am most grateful”.

Q: What about doctors? Do you have enough?

Yes. At present there is no shortage.

Q: Rapid lab tests?

Yes. But whether they are positive or not we start treatment immediately.

Q: Drugs? Medication?

Yes. But we usually don’t give patients anything more than some paracetamol. No steroids or aspirin, ibuferon or any other drugs. The problem is that most of our patients are very poor. So they choose to come here because they can’t afford to go anywhere else, especially, private hospitals.

From where do they come? we wondered.

From Piliyandala,,Mattakkuliya and some from Nugegoda, Kalutara ,and some from more distant places. It is the patients who often bring the virus with them and infect others inside our wards”.

Although the hospital had seven deaths this year, he is thankful there have been no recent deaths. We asked if there was a special dengue ward to house the number of infected patients. He laughs and says, one ward or even two or three will not be enough for the huge surge of dengue patients we are now admitting. In any case this hospital complex can’t be expanded much more. There has been no deaths these past few months.

Q: But didn’t the President this week request his officials to set up a new ward soon on your complex?

Yes. A new High Dependency with 25 beds for serious dengue patients will be built soon. Our staff is already being given a refresher training course at IIDH. We expect it to be opened on June 1. This is a very big step forward as it caters to a pressing need, as we are now in a desperate situation”.

Q: One final question. What does he see as a solution to the problem?

Dengue is a man made problem. The MOHs and Municipal Councils can’t do this work alone. If you look at the amount of uncleared rubbish, plastic sheets and plastic bottles on the roads, it shows how much the people need to be made aware of, and change their attitude on dengue. We wouldn’t have so many dengue patients he said, if people would change their behaviour. Each of us has a responsibility to keep our environment free of the dengue mosquito. If we can do this, we can avoid having another flood of dengue patients, now that the monsoon has broken out”